Peer Reviewed
Feature Article Cardiovascular medicine
TIA: prevent a stroke
Abstract
Transient ischaemic attacks (TIAs) should be considered as medical emergencies. A patient with a TIA needs rapid assessment and immediate treatment to reduce the risk of stroke and heart attack.
Key Points
- Patients with transient ischaemic attacks (TIAs) have up to a 25% risk of a stroke, a cardiovascular event or death within the next three months. Most of these events will occur within two days after a TIA.
- Urgent assessment and intervention after a TIA can reduce the risk of such an event by up to 80%.
- Assessment of atrial fibrillation, diabetes, hypertension and age allows stroke risk stratification of patients. Patients with a moderate or high risk profile need immediate referral to a TIA clinic or a hospital with the capacity to treat acute stroke.
- Patients with TIA should be treated as soon as is feasible with a statin and a platelet inhibitor, unless they suffer from atrial fibrillation or have a prosthetic heart valve. In that case, they require an anticoagulant instead of a platelet inhibitor.
- First-line antiplatelet therapy is aspirin 75 to 150 mg daily. For recurrent ischaemic events, second-line treatment is aspirin plus dipyridamole or clopidogrel alone.
- All patients should receive a statin after a TIA, regardless of their cholesterol level.
- Patients with symptomatic moderate- or high-grade internal carotid artery stenosis benefit from immediate endarterectomy. This benefit wears off with time and is much less if endarterectomy is performed later than two weeks after the event.
Purchase the PDF version of this article
Already a subscriber? Login here.